Over a Quarter of Hospital Orders Classified As Defensive

Over a Quarter of Hospital Orders Classified As Defensive

(HealthDay News) — More than one-quarter of hospital medicine services were rated by ordering physicians as at least a partially defensive order, according to a research letter published online September 15 in JAMA Internal Medicine.

Michael B. Rothberg, MD, MPH, from the Cleveland Clinic, and colleagues estimated the cost of defensive medicine on three hospital medicine services in a health system (two community hospitals and one tertiary care hospital). Using a five-point scale, hospitalists assessed the defensiveness of their own orders (tests, procedures, or hospitalization) made the previous day.

Based on the ratings of 4,215 orders for 769 patients by 36 hospitalists, the researchers found that 28% of the orders were defensive. Four physicians identified no defensive orders and 21 physicians rated at least one order as mostly defensive. Physicians with ≥10% defensive orders placed a similar number of orders (P=0.68) and generated similar costs per patient ($1,679 vs. $1,700; P=0.89), compared to physicians with fewer defensive orders. Roughly 13% of the mean cost per patient was defensive ($226 of $1,695). Orders classified as completely defensive represented 2.9% of costs, primarily through additional hospital days. Defensive orders were not associated with physician factors.

"Although a large portion of hospital orders had some defensive component, our study found that few orders were completely defensive and that physicians' attitudes about defensive medicine did not correlate with cost," conclude the authors.